Examining the Association between Healthcare Utilization and Clinical Characteristics among Cancer Patients in a Safety Net Health System

J Palliat Med. 2019 Jan;22(1):80-83. doi: 10.1089/jpm.2018.0202. Epub 2018 Sep 28.


Objective: The goal of this study was to examine the association between available patient and clinical characteristics and healthcare utilization in a cohort of breast, lung, and colorectal cancer patients within a safety-net hospital system.

Methods: Data for 979 breast, lung, and colorectal cancer patients admitted to a large, urban hospital for the year 2010 were extracted from the electronic medical record (EMR). Univariate and multivariate logistic regression analyses were performed to examine the association between relevant independent variables that were able to be captured from the EMR in discrete fields, emergency room (ER) utilization, and hospitalizations among members of the cohort. Spearman correlation coefficients to test the correlations between nonsteroidal anti-inflammatory drug and opioid prescriptions and healthcare utilization were also calculated.

Results: Of the 979 patients, 22% were 65 years and older, 43% were non-Hispanic black, 42% had Medicare, and 56% had colorectal cancer. Patient and clinical characteristics that were associated with increased ER utilization, included Hispanic ethnicity (adjusted odds ratio; AOR: 2.21, 95% confidence interval; CI: 1.52-3.21), non-Hispanic black race (AOR: 2.01, 95% CI: 1.43-2.82), and referral to palliative care (AOR: 2.15, 95% CI: 1.36-3.41). Referral to palliative care (AOR: 3.84, 95% CI: 1.47-10.0), low albumin (AOR: 2.42, 95% CI: 1.20-4.89), and presence of metastases (AOR: 1.98, 95% CI: 1.29-3.06) were associated with greater odds of hospitalization. Number of opioids prescribed strongly correlated with number of hospitalizations (ρ correlation = 0.74). Only 10.6% of patients had been referred to outpatient palliative care during the study period.

Conclusions: Some patient and clinical characteristics associated with increased ER visits and hospitalizations in this cohort include race/ethnicity, palliative care referral, markers of advanced disease, and number opioids prescribed. Increasing knowledge of palliative care and access to palliative care among the underserved should be a focus of future research.

Keywords: cancer; healthcare utilization; palliative care; safety net.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Analgesics, Opioid / therapeutic use
  • Breast Neoplasms / therapy
  • Cohort Studies
  • Colorectal Neoplasms / therapy
  • Delivery of Health Care / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Ethnicity / statistics & numerical data
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitals, Urban*
  • Humans
  • Logistic Models
  • Lung Neoplasms / therapy
  • Male
  • Neoplasms / therapy*
  • Palliative Care / statistics & numerical data*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Referral and Consultation
  • Safety-net Providers*


  • Analgesics, Opioid